Newly Diagnosed Diabetic Cat - Sammy

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Margaret

Margaret

Member Since 2014
Hi all,

My 14-year-old cat was diagnosed with diabetes just over a month ago. He was drinking a lot of water and urinating large boulders. His coat was terribly greasy and flakey. He had lost a few pounds, down from just under 20 to about 16 and a half. (He is a very long-bodied cat, besides being overweight for many years.)

We started him on 2 units of Novolin (NPH) every 12 hours. Two+ weeks later, a fructosamine blood test resulted in the vet telling me to increase to 3 units every 12 hours.

At the new dose of 3 units I was pleased with the improvement in his overall activity level, the look in his eyes, and the improvement in his coat. The Novolin cost $55 for a 10 ml vial, plus a $20 annual "discount club" fee (without which the cost would have been $94 for the vial).

Subsequently, I learned that I could get the supposedly comparable Humulin (NPH) through my employer (a medical facility) in a 3 ml vial (less waste) for about $9. I made the switch this past Wednesday, so have been giving the Humulin for just 5 days now. Our plan had been to take the next fructosamine test after being on the Humulin for a full two weeks.

However, Sammy seems less interested in eating, seems sleepy, somewhat glassy-eyed, and his coat looks bad again -- greasy and flakey.

Looking around online, a couple of petmed companies say that Novolin requires a 12-hour dosage and that Humulin has a 24-hour dosing schedule. While I'm not sure this is true, I am worried about what is going on.

Of course, I will call the vet tomorrow, and plan to research if anyplace offers the Novolin (since he seemed to be better on it) in a 3 ml vial and at a more affordable price, as cost is a concern for me, with several other pets under my care, as well.

I'm reading around on the site and trying to absorb the information, though it can seem daunting with all the testing and curves, etc.

Mainly, at this point, I want to figure out if there is truly that much difference between Novolin and Humulin, or if there might be something else going on with Sammy, and how to get him back on the better track he was on.

Thanks for any help you can give!

Margaret
 
I wouldn't bother researching who has the best price on Humulin or Novolin. NPH type insulins (Novolin N, Humulin N) hit hard, drop the glucose fast, and wear off fast - within 6-8 hours in cats. Those other numbers may be for dogs, which have a lower metabolism. This leaves 6-8 hours with the glucose uncontrolled. Giving the insulin 3 times a day, every 8 hours, is one of the ways to work around that. They are not the most optimal insulins for cats.

The better insulins for cats are PZI, ProZinc, Lantus, and Levemir. All of these last roughly 12 hours in the cat. If you get Lantus or Levemir, get it in the pens, which contain 3 mL and can be used completely before expiring.

We advocate home glucose testing so you can be sure it it safe to give insulin and that the insulin is not taking the glucose too low. You use an inexpensive human glucometer with reference levels for cats. The WalMart ReliOn Confirm, Confirm Micro, and Prime are all inexpensive and take small amounts of blood. If you abhor WalMart, you can pick up an unbranded version, the Arkray Glucocard 01 or 01 Mini at American Diabetes Warehouse, through our shopping link above. A bonus is that testing at home reduces the impact of vet stress which may raise the test levels 100-180 mg/dL and reduces your costs, as you can do a curve at home - repeated tests at 2 hour intervals - and save money that way.

An additional way to save on costs is by feeding low carb, over the counter, canned or raw food. Veterinarian Dr Lisa Pierson explains why at her web site Cat Info. Most of the Friskies pates are less than 10% calories from carbohydrates, as are the Fancy Feast Classic pates.
 
Thank you, BJM!

I am feeding a good quality, grain-free low-carb canned food -- Dave's Naturally -- and supplementing with dry Taste of the Wild. We have two other cats, as well, who prefer the dry food, and it's hard to monitor exactly who eats what, but I've increased Sammy's portions of canned food so I do see him eat a good meal prior to each injection.

I will check about the availability and cost of the other types of insulin this morning -- thank you for the info! Sure wish the vets were better-informed about this stuff. Of course, they want me to feed their Purina DM food, but after reading the label, I opted against it.

The vet gave me a One Touch meter but didn't recommend I start using it yet, until we get Sammy somewhat stabilized. Even when he demonstrated it, he had difficulty getting a large enough drop of blood from the ear to get a reading. I don't want to poke Sammy's paws for testing, as he shares litter boxes with the other two. I don't love Walmart, but I do go there and will see about the ReliOn glucometers.

Thanks again!

Margaret
 
You said "Looking around online, a couple of petmed companies say that Novolin requires a 12-hour dosage and that Humulin has a 24-hour dosing schedule."
Novolin is a family of Recombinant DNA origin insulins made by Novo Nordisk, a Danish company.
Humulin is a family of Recombinant DNA origin made by E I Lilly, a US company

The only such insulin acceptable for cats is N, sometimes called NPH made by both companies. Walmart sells their own brand of N (NPH) for about $40 or so. With N (NPH) dosing three times daily is best.
With Lantus/Levemir and ProZinc, twice daily is used.

ProZinc is Recombinant DNA origin with a protamine-Zinc additive that extends the duration longer than just the Zinc additive in N (NPH) insulin
 
There are other insulins that work better for cats, Lantus & Levemir. If you are in the US, both manufacturers offer discount coupons on their websites for the pens. They average $25 per pen. They are longer acting insulins and cats respond well to them. If you switch, ask your vet for the prescription for the pens and not the vial. Because they are packaged in smaller containers, the insulin will remain effective longer. Depending on your dose, one package of pens (5) could give you enough insulin to last almost a year.
 
Hello Margaret and Sammy, and welcome to FDMB!

Because of the symptoms you're seeing in Sammy ("Sammy seems less interested in eating, seems sleepy, somewhat glassy-eyed, and his coat looks bad again -- greasy and flakey.") I would strongly suggest that you do have a go at hometesting. It could be hugely helpful to know what is going on with his blood glucose on a day to day basis.

Hometesting blood glucose is, in essence, a simple and quick process, but like anything new it will probably take a few goes to get the hang of it (so be kind to yourself).
Cats' ears bleed best when they are warm. Some folks massage an ear to warm it, some use a little pill bottle filled with warm water to hold inside the ear to warm it. But after a little while the ears do seem to 'learn to bleed' more easily. The edge of the ear grows new blood vessels which makes our job a lot easier.
A teensy smear of vaseline on the outer edge of the ear will help the blood to 'bead up' and stop it disappearing into the fur.
And massaging gently below the prick site can 'milk' out a little more blood.
Sometimes two ear pricks close together will produce enough blood for a test, where one ear prick might not.
It is also really helpful to reward the kitty for tests (or attempted tests) by giving a low carb treat or a wee cuddle. You may be surprised to learn that many cats come to like being tested because of the attention they receive. cat_pet_icon

Here is a link to a page of pics and info about hometesting:
http://www.sugarpet.net/bloodtst.html

I would also urge you test Sammy's pee for ketones, especially given that Sammy is showing less interest in his food. (Diabetic cats are usually very hungry if there are no other health issues going on.)
You can get a tub of Ketostix or Ketodiastix from a pharmacy. (Ketostix test for ketones, Ketodiastix test for ketones and glucose.) My understanding is that anything above a trace level for ketones is a reason for a vet visit ASAP.
Here is a link to a page of pics and info about testing cats' urine using Ketodiastix:
http://www.sugarpet.net/urine.html

Regarding meters, I also have a One Touch meter and absolutely love it. But I don't know if the cost of test strips is higher where you are? (I'm in the UK and buy mine for half price on Ebay).
Many US folks here do use the Relion meters.

I know there's a lot of info to take in at first, and it can be a pretty steep learning curve. But you will get the hang of things. And I've a feeling that you're going to do just fine!
Please ask any and all questions you want to.

Welcome aboard!

Eliz
 
Thanks, everyone, for the welcome, information and support!

One thing I forgot to mention before is that Sammy also gets a psyllium fiber capsule sprinkled over his wet food twice daily to help prevent constipation, and some probiotic powder once a day.

I want to request a prescription for Lantus, which I know my vet is going to resist. He has stated a couple of times that they "tried the longer-acting glargine, but it didn't work very well." I have a hunch from reading around that maybe they were trying it as a once-in-24-hour dosage (like for humans?) and perhaps that's why they didn't think it worked well, if cats need it every 12 hours.

It seems the NPH we've been using (first Novolin and now Humulin) does better with an 8-hour dosage, but that isn't feasible for me with a long workday that can extend 10-11 hours.

So I probably need to convince my vet to let me try the Lantus, but perhaps I should get going on taking BG tests and see where we're at starting this morning. He had his injection before 6 a.m., but I should get the supplies out and start getting adept at the testing. I admit, I don't understand the spreadsheet yet, but I think if I simply record the date, the BG number and the number of hours post-injection, that's all I need to start, right?

One fear I have is this -- on days I work, I have to "fudge" the insulin schedule a tad (by an hour or so), resulting in sometimes giving the injection at 11 hours, not 12. If the Lantus is TOO long-lasting, will I create a problem with overlap in dosages? On days I work, there's no way I can delay the morning shot, and I can't leave work to come home and give it later, even if morning BG testing showed the need to wait.

In view of this, is Lantus still the best option?

Edited to add: Well, I was not successful on my first BG testing effort. I put in a new lancet and had the strip and meter all ready to go, but couldn't get enough of a drop to test. I used the lancet three times on his inner ear edge (depth setting of 5) after massaging it for a while, and couldn't work out any blood at all from any of the three attempts. Turned up the lancet setting to its maximum depth of 7 and tried a paw pad twice, and worked out two tiny drops but not enough to fill the strip. I finally gave up when Sammy placed his teeth on my hand to tell me "enough." I have to get ready to go somewhere so will have to try again this afternoon. Incidentally, I did this process on myself a few weeks ago when I first got the meter, and was able to successfully use the lancet (depth setting of 5) and meter on myself, so I feel like I'm doing it correctly. Not sure why I can't get enough blood from him.

Thanks for any suggestions!

Margaret
 
Hi Margaret,

Well done for for trying to test!
You might find it easier to prick the outside of the ear (did I understand correctly that you're pricking the inside..?).
And usually, on the occasions when I can't get enough blood, it's because I'm not putting pressure on the opposite side to where I'm pricking the ear. So, I prick the outside but also put a finger tip against the inside of the ear to act as a resist. Some folks use a piece of cotton wool or folded tissue (just in case you prick your finger at the same time!)).
You will get the hang of it, honestly!

Regarding insulin, my understanding is that Lantus works best if dosed 12-hourly (because it's long lasting and works on overlap). If you have the kind of schedule that makes it difficult to give shots every 12 hours then it may be that using PZI/Prozinc would work better for you. It allows more flexibility with the timing of the shots.

Eliz
 
Yes, Elizabeth, I was pricking the inside of the ear. Will try the outside, with the Vaseline as suggested for helping keep the blood from disappearing into the hair, and pressure on the other side, which I wasn't doing.

I just bought a different lancet tool with lancets that are 26 gauge, for alternate testing sites. I take it they will make a bigger hole and might get me a bigger blood drop? (I hope Sammy doesn't hate me for that.)

I was shocked at the price on the test strips for the One Touch, so will probably be buying one of the ReliOn glucometers, as the strips are much cheaper.

I am surprised to find how much the info varies from pharmacy to pharmacy. One pharmacist tells me that PZI and Prozinc insulins have been off the market for years and are not available for humans -- only as Vetsilin for animals. (This is incorrect, right?) Apparently neither Walmart nor my employer can get the PZI or Prozinc.

I was also told that the Lantus discount card is probably only for humans and won't work for veterinary usage....anyone know for certain if we can use the Lantus (and Levimir) discount cards for cats and which retailers honor them (in the U.S.)?

Failing the Lantus or Levimir discount cards, it looks like my options right now would include: a 3-pack of 5 ml Lantus pens for $264; or a 3-pack of 5 ml Levimir pens for $180. Any advice on how long these might last, so I could see what my per-month cost might be and if I can justify it with regard to my income?

Sorry for all the questions -- I just want to have my ducks in a row and to know I can AFFORD a different insulin before I approach my vet to request a prescription for something he thinks isn't the best choice.

Thank you!

Margaret
 
12/12 hour dosing is best for Lantus. How 13/11 hours is OK. A couble of years ago my cats were on an 8/16 hour dosing one weeks ends because of my work schedule
 
Thanks for the info, Larry!

I think Sammy is looking and acting some better, still on the Humulin N, at this point. I have to work today, but will try testing again tomorrow. I want to be able to put some numbers to the picture, and not just rely on my subjective judgments.

As I think about the costs of Lantus and Levimir, I am concerned about getting Sammy onto something that I would suddenly be unable to afford if they suddenly stopped offering the discount cards.

Lots to think about and learn about!

Margaret
 
Lantus and levemir last up to six months if you keep them in the fridge. If you buy a pack of pens , the six months only applies to when you "open" one. The rest will last until the labelled expiry which is over a year out normally

Plus if you are super diligent right now in terms of food, insulin (a good one) and home testing with protocol dosing there is a high chance of remission.


Wendy
 
Here's a quick guide I wrote up for help differentiating between the different types of insulin that you might find helpful. There are also links in there for the Lantus Savings Card and the Levemir discount. My Michelangelo has been on both Lantus and Levemir and I used both the Lantus and Levemir cards successfully (cat must be 18 years old and you're the caregiver/guardian) at my local Walmart. They also sell me the pens individually so that helps offset the cost and I only have to spring $25 for insulin every couple of months instead.
 
Thank you, KPassa!

Even with making the cat 18 years old, with me as the caregiver, won't there be a problem with the pharmacist knowing it's a pet, since the prescription will be written by a DVM, not a physician for humans? I live in a small town and if getting the Lantus or Levemir at discount hinges on representing the patient as a human, I can't do it.

Screwing up my courage to try a BG test....

Margaret
 
So discouraged and frustrated at the moment. One hour after the insulin shot, I got a BG reading of 562. Shouldn't the (NPH) insulin have kicked in by then?

Tried to test at +2 hours, and after five sticks in the ears and a stick in the pad, and not getting enough blood, I tried once more in an ear, got enough of a drop going, applied it to the strip, and the flippin' meter read Err 5. The spot was still bleeding, and not having time to consult the meter's manual before losing the opportunity, I used a second strip and got Err 2. By this time, poor kitty had had enough of my "attentions."

I was using the free meter (that requires very expensive strips) from the vet's office just until I use up the strips that came with it, but am so done with that sucker now.

Heading to Walmart today to get a ReliOn meter and cheaper strips, and hope to God I don't get these error messages, or I will lose my mind.

Sorry to vent. I know I'm not the first, nor the last, to become aggravated over learning to test.

Margaret
 
Without more BG information like past BGs', I can't put the 662 in perspective. Did you do a preshot this morning?
Maybe time for a an insulin change. Will post some of my MurFee's BG later. He did not do good on N.

MurFee on 4 Units N
AM Preshot 396
+2 447
+4 486
+6 570
+8 445
+10 497
PM PS 534

4U N
3/22
AM PS 446
+2 361
+4 432
+6 415
+8 527
*10 511
PMPS 450

On 6 units NPH twice daily
511@4AM reading before eating and right before shot
489@6:03 +2 hr
546@8:03 +4
544@10 +6
HI (>600)@12:12 +8
520@2:03 +10
514@3:55

8U N
AM preshot  415
+5 HI
+7 HI
+12 /PM preshot 505

MurrFee is doing a lot better on Levemir, This morning I got a PS of 295. He is on 10 U Levemir
 
Margaret said:
Even with making the cat 18 years old, with me as the caregiver, won't there be a problem with the pharmacist knowing it's a pet, since the prescription will be written by a DVM, not a physician for humans? I live in a small town and if getting the Lantus or Levemir at discount hinges on representing the patient as a human, I can't do it.
Click to expand...
My pharmacist knows it's for a cat. They even ask after him whenever I come in. :lol: The discount is for the prescription, not the patient. Since the prescription is not covered by insurance or any other aid, it qualifies for the discount.
 
So, KPassa, it's in applying for the discount card from the maker of Lantus that Sammy needs to be 18, not when I pick up the prescription from the pharmacy?

Larry -- it was the first (and only) BG I have successfully completed so far, so no, I didn't have a preshot number to compare to -- I'm just learning to do the testing. My goal is to be able to compile some data so I know what the NPH is doing (or not doing) for Sammy, so I can convince the vet (if data bears it out) to write a prescription for Lantus, which he says he's not had good luck using. My hunch is that they were using it for 24-hour dosing, not 12.

Anyone having trouble getting the website to load this afternoon? It took me over an hour of trying before I could get it to open.

Margaret
 
Margaret said:
So, KPassa, it's in applying for the discount card from the maker of Lantus that Sammy needs to be 18, not when I pick up the prescription from the pharmacy?
Click to expand...

Right; just for applying for the card. The pharmacy looks up Michelangelo's prescriptions by his birth-date (4/13/2012) so they know he's not 18. ;-)

And yes, there have been some problems with the board lately, but they're being worked on. If you have problems accessing the board and need help, if you have facebook, you can post in the facebook group in the meantime.
 
This testing thing has me flummoxed. I have only successfully tested Sammy three times, and each time, it took five or six pokes with the lancet to get a big-enough drop of blood. Of course, each unsuccessful try also required five or six sticks, after which he has lost patience and wouldn't cooperate any longer.

I massage his ear beforehand, I've used Vaseline (which I think once resulted in an error message on the meter, as it maybe sensed that the sample was "contaminated"), I've rubbed and "milked" the spot to try to get more blood, and I've tried poking his pad, which definitely hurts him, resulting in him biting me and the session ending. I can't see veins in his ears, and I don't have a third hand to hold a flashlight.

I'm using a 26 gauge ReliOn lancet with the tool set on the deepest poke (5). Of the three successful tests, two were drawn from inside the ear (no Vaseline) and one from the outside (with Vaseline).

Why won't my kitty's ears bleed just that tiny bit more that I need?!

I'm getting so stressed out and upset that I don't know if I can stick him any more. He is surprisingly compliant, but his patience with being repeatedly stabbed is only going to last so long, and I'm afraid he will start to avoid me, making even the shots a problem.

I feel terrible poking him so many times for no results. If I could be sure I could reliably get enough blood the first try, I could do this. As it is, I don't know how much longer I can stomach the testing attempts.

Any more advice on how to get enough blood before I give up on testing and just go with the two-week fructosamine tests at the vet's?

Thanks in advance for any help or encouragement you can give! I love my Sammy and want to do what's best for him.

Margaret
 
Ideas:

You can aim directly for the vein. And be prepared to blot if/when you hit it as you will get a very large droplet or more.

If you cannot see the vein, shave the ear (carefully!).

Two quick pricks next to each other may get more blood. That means keeping an eye on where your pricked so you can aim. I have crappy vision, so that is tough for me.

Milking the ear - after you prick, massage upwards towards where you pricked. Also see if spreading or stretching that section of ear opens up the hole a bit.

Reward Sammy for his patience and compliance - low carb treat, kitty massage, play, a bit of catnip - whatever he likes. My Gracie likes to be snuggled up next to me, so its part of how I hold her for testing.
 
Oh, Margaret, I do so feel for you....

I still occasionally have trouble getting blood out of Bertie, and the reason in our case is almost always that I'm not putting pressure on the inside of the ear (opposite to where I'm poking). The lancet needs something to 'resist' otherwise it can push the ear away. So I put my finger tip against the inside while poking the outside (some folks use a piece of cotton wool or folded tissue to avoid pricking their own fingers!)

I can't see the veins in Bertie's ears either. He's black and my close vision isn't great. So I just aim for the general area and hope for the best! But for over 7 years this rather haphazard approach has served us pretty well.
You may find that moving slightly further inwards or outwards from where you're poking will work better. And many of us find that one ear bleeds better than the other (strange but true...)

Here is a link to an FDMB page of tips and videos on hometesting:
viewtopic.php?f=14&t=287&sid=acd16252f3a2e50703e445681a6f2ed7#p1665

Sending you a huge reassuring (((hug))), Margaret

Eliz
 
Thank you both for the encouragement!

After a half hour of frustrated tears this morning, I tried again, and have since gotten two successful tests! The first one only "cost" two pokes, and the second result "cost" three pokes. I did what seems rather dastardly and poked his ear in the same spot as where there is a bruise inside from a previous poke. I figured there must be a vein under there to cause a bruise, right?

Sammy, who has always enjoyed having his ears handled (unlike our previous cat, who hated having his ears touched), is now pulling away from me when I go to handle his ears. So, I've GOT to get more skilled and quicker at this. He does like his freeze-dried chicken treat afterward.

I am finding that the new ReliOn Micro meter seems to require a smaller drop of blood than the OneTouch UltraMini. The OneTouch is very quick to give an error message for a too-small drop. In fact, I can't even find where it tells what quantity of blood is required, whereas the ReliOn Micro says it needs only .3 microliters. So maybe I will get better at gauging the required droplet size and find that I don't need as big a drop as I did with the UltraMini.

So, my results so far are:

+3 (3 hours post-shot) BG reading of 242
+6 BG reading of 210

So.....maybe I'm on the way to getting a curve plotted...(deep breath).

Thanks again! Heading over to look at the page of tips on hometesting....

Margaret
 
Great job on learning to test! The first few weeks can be frustrating, especially since they haven't yet "learned to bleed" (angiogenesis). One thing that might help is taking away the feeling that you absolutely must get a successful test in every time. Try taking your time and just practice, practice, practice! Not every attempt to test has to give you a number. It took me a week of trying before I got my first successful test in. Now it's easier than feeding them and Mikey jumps up to his testing spot whenever I say "ready for a test?" You'll get there...eventually. Just have patience and keep trying. ;-)
 
Thanks, KPassa! Looking at the photos of the "sweet spot" helped, and now I've gotten two more successful tests.

Starting to see the curve:

+3 242
+6 210
+7 293
+8 316

For the latest two tests, Sammy didn't even leave his napping spot on a ledge on the cat climber tree! Perfect level for me to work with him, too.

Margaret
 
Hi Margaret,

I'm a little late, but I wanted to welcome you to FDMB. It's great that you've started getting some tests in. I can totally relate to the frustration you have with it. When we were first learning how to test, we had many failed tests and lots of tears. We never did get the hang of ear testing and ended up testing on the paw. Warming her paw first with a heated rice sock and using Neosporin (gel, not cream) were the keys for us. Even then, we still occasionally had failed tests. In fact, I just tried a couple of days ago to get a test and wasn't successful with it. Don't beat yourself up about those instances; they happen to all of us! And you definitely will learn to gauge the size of the drop needed. Many times, my husband said "that's not enough," and I would reply with, "yes, it is!" I was always right, of course! :lol:

We started out trying the Hill's w/d dry food (based on the vet's instructions) and finally started using Humulin after the food change didn't help. After I found this site, I went to another vet for a second opinion on Jersey. That second vet is actually the one who prescribed Lantus for us. We also made the switch to low-carb canned food. We were definitely blessed - after just a few months on insulin, Jersey is officially in remission.

Hang in there. I know all of this is overwhelming in the beginning!
Shelly
 
Hi Shelly! Thank you for the welcome! You are right, that it seems overwhelming at the outset. I'm learning to "eat the elephant, one bite at a time." Congratulations on Jersey's remission!

I'm refining my testing technique, such as removing my glasses and leaning in closer to have a better close-up view of the blood speck. I made a little rice sock for warming the ear if it feels cool, and Sammy seems to like that part.

I think testing is going to show that Humulin wears off too quickly for Sammy, but I need to have that data in order to have a basis to ask the vet for the Lantus or Levemir prescription. I have a 20-year relationship with this vet's office, and five pets currently under their care. I live in a small town and there aren't very many vets in striking distance. I think if I present valid data diplomatically (vets and doctors hate to hear their clients say "I've been reading on the internet") he will go along with me.

Thanks again for your welcome and encouragement!

Margaret
 
Thanks, BJM! That article should be very helpful in talking to the vet.

What a difference a day makes! I've poked my kitty almost all day long, and he's been soooo good!

preshot 566
+3 243
+4 189
+5 146
+6 149
+7 170
+9 174
+11.5 (preshot) 536

I regret that I missed hour 10, in particular, as I'd like to have known more closely when the BG shot up, but I had to go to the store. It's a good start for seeing where we're at.

Now Sammy will get most of a couple days free from constant pokes, as I have to work the next few days.

Margaret
 
I started a very simple Excel spreadsheet and will look deeper into the more complex spreadsheet later this week when I have some time off work.

The dry I'm feeding is grain-free; however, I know that doesn't mean there are no carbs. I don't think I can eliminate all dry food, as the other two kitties prefer it greatly. I give them each a little lump of wet food at each feeding, but they rarely eat it.

When I got home from work today, Sammy was looking pretty tough and wasn't interested in eating anything except some baby food chicken. I began to study him more closely and discovered that his chin is swollen and tender. Called the vet's office right at 5:00 and they said to bring him right over -- they'd wait for me.

The vet couldn't examine inside the mouth at all due to Sammy's discomfort level, but he thinks it's infection from feline acne, and gave Sammy an injection of Convenia (antibiotic). He said it would take up to 48 hours for maximum effect and told me to call tomorrow afternoon and report how Sammy is doing at that point. Of course, now I'm worried about any side effects of the Convenia, but there is no way I can ever get oral medication down him, let alone now that he doesn't want his head touched at all.

My poor baby....it's one worry after another....

Margaret
 
Poor baby.

The good news is any infection can spike blood sugar so he may come down into better numbers once it's treated.

You could try pill pockets for oral meds. My cats love them.

Have you seen these dry food transitioning tips? I would hate you to have another cat turn diabetic.. http://www.catinfo.org/docs/TipsForTransitioning1-14-11.pdf. However if they don't work after trying hard and a lot of patience, you could try low carb dry foods like Innova Evo Cat & Kitten 8%, Nature's Variety Raw Instinct chicken 7%, and Young Again zero Carb . I prefer pizza greatly over salad but I don't get it every day, so time to be tough on your kitties too ;) it's in their best interest.


Wendy
 
Hi Shelly! I'm late to the party but wanted to say welcome! Sounds like you're really getting the hang of testing...good job! Took me awhile to get it too.

Sounds like your poor baby is just having a tough time. When it rains huh?

You're doing great though! Just wanted to send so e encouragement to you and healing vines to your kitty!
 
Thank you, Rachel and Wendy!

I'm trying to find out the actual carb content of the dry I'm feeding the other two kitties, and which Sammy has a nibble of now and then. It's supposed to be low carb but I'd like to compare actual numbers. I am especially concerned about one of the other two kitties, as she is overweight and extremely sedentary due to a chronic respiratory disease. She won't eat the wet food, but eats too much of the dry, in spite of the fact that she hardly has any teeth. She just swallows the dry food whole.

Back to Sammy -- his chin abscess burst open last night at 9:30. I talked to the on-call vet and he said my description all sounded like the normal progression, and that we could be seen in the office today. Now that Sammy is more comfortable (since the pressure has been relieved), maybe they can do a better exam and see if it's originating from a tooth or if it's really chin acne gone bad.

I know we all love our cats, but I just gotta say what a good kitty Sammy is! He is so tolerant, and responsive to praise and requests to the best of his ability, even when he is in pain. He does hate going in the car and to the vet, so I'm sad to have to do it to him again so soon....he's such a good boy.

Margaret
 
Things are going pretty well right now for Sammy. The abscess is healing up nicely and the vet was certain it wasn't a tooth, but a wound, probably from one of the other cat's claws or teeth.

Sammy was looking poorly for a couple days earlier this week, but seems to be feeling better now. I think it was because I'd stopped his psyllium fiber for a few days, and he was probably getting constipated. I'd stopped it because he wasn't eating even the canned food very well unless I put quite a bit of water on it so he could just lap it up. I was fearful the water would make the psyllium gum up in his throat or esophagus and cause him to choke. Now that I'm again putting the fiber onto his food, along with just a little water, he seems to be eating better again.

We've had a recent problem with him urinating in places other than the litter box -- mainly on top of any plastic bag or paper he could find. He was getting so much extra water with the added water on his food, and I think he didn't feel up to making the trip to the basement. I've been making sure to get him started downstairs a few times a day, and think the problem is waning. There is no place to put a litter box on the main floor as it's a small house and the dogs will eat the (clumping) litter, and possibly get a blockage of their own.

I brought in a couple leaves of fresh catnip for Sammy this morning and he "cuddled" them and enjoyed them thoroughly!

Thanks for asking, Wendy!

Margaret
 
How's his blood sugar?

It sounds like he is peeing a lot, which means drinking a lot, which is a sign of uncontrolled diabetes, and high blood sugar..
 
Sammy is definitely still drinking a lot of water and hangs around the bathtub and sinks, wanting me to turn them on, even though water is always available in the pet dish.

He peed on the floor in the laundry room again overnight (and on the shoes and rug, etc. which were there). My husband's tolerance is not very good when it comes to this aspect of the problem, so I need to figure something out pronto.

I'm going to try to do a curve today, though I have to be gone for a while, so won't be able to test every hour.

The last curve I did showed that the insulin was getting him into that range between 100 and 200 for several hours, and the vet was satisfied with it, even though the insulin wears off before the next dose is due and he goes back up into the 500's. (I am still using the NPH.)

I talked to my vet again about the glargine. I thought perhaps they'd given up using it because they were unsatisfied with the results from using it once every 24 hours, and I was poised to try to convince them to let me try it every 12 hours. Well, it turns out, they were using it every 12 hours, and they were having difficulty with hypo reactions, and after consulting with some other vets, arrived at the conclusion that the glargine required too close of monitoring to be practical for pet owners who aren't home during the day to watch for hypo reactions, and to be able to stay home and delay the shot if BG testing shows the need.

That, combined with the high cost, caused his practice to stop using glargine. He didn't seem convinced that the $25 discount card was something he could legitimately recommend to his clients, as he's certain it's intended for humans without insurance, which I respect his feeling about that -- I have great difficulty with putting my cat on a drug that I suddenly might not be able to afford if the discount disappears.

I may need to get a urine sample tested. I think it has a different smell to it -- could that be caused by the insulin? Actually, when I think about it, it's probably the sugar spilling into the urine from when his BG goes back up out of optimal range. It sometimes even seems a bit sticky if it's sat a little while before I find it to clean it up.

Margaret
 
Over the counter urine test strips are available to test for glucose and ketones (ex KetoDiaStix). If there is a fruity or nail polish like odor, that can be ketones. (2 of 3 ketones smell like that)

Ketones are made when the body breaks down fat for energy. Too many ketones may indicate diabetic ketoacidosis (DKA), a potentially fatal and expensive to treat complication of diabetes.

If you can, pick up some urine ketone test strips and get a test asap. If there is more than a trace level of ketones, it is a medical emergency and you should get your cat to a vet asap.
 
I will get some strips today. I also just made a vet appointment for this afternoon, as I don't want to let this go, especially going into a long weekend.

Sammy's eating well and the BG curve today is looking "normal," at least following what it has been, but I think he's still been losing weight and not looking very strong or energetic. This morning as I was doing his testing, I thought his breath smelled rather strong.

Thank you so much, everyone here, for your kind and frequent attention to all of us trying to figure our way through this!

I'll post again after our vet visit this afternoon.

Margaret
 
At Sammy's vet visit, the vet sedated him slightly and cleaned out a significant amount of hard, very dry stool from his lower bowel. She gave him subcutaneous fluids, expressed his full bladder and observed the stream to be sure there was no blockage, took a urine sample (which was clear of bacteria and crystals), took a blood sample for a "blood chemistry vet panel," and gave him a B12 shot.

He had been looking thin and bony, but I learned he hasn't actually lost any more weight since the visits for the chin abscess -- the dehydration probably caused him to appear thin and shrunken.

I'm supposed to call back in the morning to get the blood test results and update the vet on how Sammy seems to be doing. He ate a good supper when we got home and definitely looks better with the extra fluids plumping him up. He seems to be resting very comfortably, so I'm hoping we're on track for perking him up.

Edited to add: I did talk to the vet today (there are three vets at the practice, so this was a different one than last time) about glargine. She said we could try it if we can't get Sammy into a better place with the NPH. Her concern is also that, where we live, emergency help for hypo reactions on evenings, weekends or holidays is an hour away. She has a vet friend in a large city who uses glargine with many patients, but they have emergency vet help readily available 24/7 for hypo reactions. They also frequently keep cats in clinic around-the-clock while they work to find the right dose.

Margaret
 
Update -- got blood test results this morning, and though Sammy's BUN was slightly elevated, the creatinine was normal, so the vet didn't have a lot of concern about the BUN at this point. Everything else was normal. Sammy is looking and acting much better today than yesterday -- more interested in life in general.

The vet also said if we are not able to get Sammy stabilized better with the NPH insulin, we might try PZI. She said that, while expensive, the bottle of PZI lasts much longer without expiring (even after it's opened), so the investment can cover a long period of time. I haven't researched that yet -- can anyone confirm that PZI doesn't expire for many months even after it's opened?

For now, we are trying some tighter diet management. I realized that his treats, while grain-free, may be spiking his BG, so I'll stick with small bits of baby food chicken or dehydrated chicken, etc. for treats.

The B12 shot typically lasts about three weeks, so if he does well for three weeks and then drops off, we may want to repeat that. Also, they will teach me how to give him fluids if he starts to need them on a regular basis.

Margaret
 
We have a very specific protocol for using Lantus based on the work of Roomp and Rand who did the research with the Diabetes Katzen group based in Germany/Europe. It includes feeding low carb over the counter food, home testing before every shot with periodic mid-cycle checks to monitor how low the cat is going, plus using instructions for managing hypoglycemia at home. Dose increases are small - 0.25 units at a time unless ver high - and regular testing is highly advised until a good stable level is achieved. This helps guard against hypo risks and complications. Pop over to the Lantus Tight Regulation forum and read over, maybe print the sticky posts. Share them with your vet, too.

There is a formula for determinig the initial dose based on lean weight:
Take the lower of current weight or ideal weight
Convert to kilograms (pounds / 2.2) if needed
Multiply by 0.25
Round down to the nearest 0.25 units.
- note: you'll have to eyeball increments of quarter units as syringes don't mark those.
 
Yes, I have read the tight regulation protocol for Lantus, and it seems rather daunting. I work unpredictable shifts that are 10 - 12 hours, and I have to be able to fudge the injection time up or down about an hour according to the day's schedule. I have no option for going late to work if a BG reading says an injection needs to be delayed. With three cats, it's difficult to regulate the food precisely or insure snacks during the day when I'm at work. I just can't abide the thought that a hypo reaction could be happening because I'm not there to do BG testing or intervene several times every day.

I also have two dogs that require daily exercise and training, a family to care for, and extended family members with health issues. I am extremely dedicated to my pets, but I just can't dedicate any more hours in a week to them than I already do. Because of the tight monitoring required for Lantus, I don't see it being the best option for us at this point.

Margaret
 
PZI or ProZinc are more flexible and preferable to Vetsulin/Caninsulin which may not last long enough.
 
Thank you, BJM!

I'm also intently focused on getting the inappropriate urinating problem solved. Last night, I took Sammy to the basement litter boxes before bed and made sure he used one. Then I put a litter box out in the laundry room (which is really just a small entryway with the washer and dryer in it -- not much space at all.) I was up at 4 a.m. and checked, and it had been used. So, thinking I was safe for a while (as the peeing has been mainly happening overnight), I moved the new litter box to the basement for the day (trying to keep marital harmony, too).

I went back to bed, and when my husband got up, he caught Sammy peeing in a basket of shoes in the laundry room. So, for now, all shoes are out of the laundry room (some outside drying after being hosed out), and the new litter box is there. The other cats have decided to use it, too, so I'm scooping it frequently and vacuuming/sweeping around it to pick up the tracked litter. The cats and I are very unpopular with the humans here today. :-(

Sammy has always been very good about using the litter, but I think it's just a lot of effort for him at this age and not feeling totally great, to get all way downstairs to the usual boxes.

Margaret
 
With diabetes, the body uses water to help flush out the excess glucose. This results in a full bladder, very quickly. If he isn't able to move quickly enough, he may just have to go.

Vets recommend 1 litter box per cat plus an extra, distributed around the home in quiet locations. Too many cats trying to share one box and you can get turf wars happening with 1 cat blocking another from the litter box, or attacking the cat while in the litter box. And cats will go after one that is ill.

To save your sanity and your marriage, consider using tarps to protect things you don't want peed upon - like beds, laundry, furniture, etc. Until the diabetes is well controlled, this is likely to remain a problem


p.s. once this thread has 50-51 posts, it'll go to a new page. You'll see then numbered in the upper right corner of the post's top.
 
As of today, we have four litter boxes for three cats. (It used to be three boxes for two cats, then three boxes for one cat, and then our daughter's two cats landed here!) Locations are limited due to a small house and lack of some family members' tolerance for "real estate dedicated to pets."

Though the boxes are all in the same location there has never been any problem with sharing. Two of the boxes are oversized (shallow storage boxes), I scoop them daily and I'm certain it's Sammy's health problems that are causing his inappropriate urinating. If I walk downstairs and call him along with me or carry him, he'll use the normal boxes if he has the urge to go. I'm sure it's just that frequent trips down there are hard with some arthritis in one leg, etc.

He seems to have chosen the laundry room as the favored spot, and he's been using the new box there all day. My plan is to keep it there for now. We're keeping the bedroom doors closed to keep the cats out of them.

Sammy has acted like he's been feeling pretty good all weekend. :-)

Margaret
 
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